residual disease. Radiation therapy plus chemotherapy has been used as an alternative to surgery for patients with inguinal lymph node metastases.
External radiation therapy with chemotherapy is now the first line of therapy, resulting in a 90 percent local control. An alternative is interstitial implants of iridium with external radiation therapy, without chemotherapy.
The first choice of treatment should be radiotherapy with chemotherapy for small or even large, but not huge, lesions. Whether to give chemotherapy before radiotherapy or simultaneously is now being evaluated, although current reports recommend the simultaneous use of radiation and chemotherapy.
When all the tumor is eradicated by radiation and chemotherapy, careful follow-up is vital. The lymph nodes in the groin have to be watched carefully, since the most common site of local recurrence is in the pelvis and lymph nodes. If the tumor recurs, salvage surgery will be needed.
Treatment of the less common adenocarcinoma involving the upper portion of the anus (near the rectum) differs from treatment of squamous carcinoma . For smaller lesions, local excision or fulguration may suffice. For larger lesions, an abdominal-perineal resection may be required. Combined radiotherapy and chemotherapy is not as useful, although rectal adjuvant chemotherapy and radiotherapy programs can be employed. In selected cases, interstitial implants of iridium with external radiation therapy may be an alternative.
